ER Doc wanting to remove High Flow O2 from protocol

[VentMedic]

The ER doctor is not the final word on the O2 delivered to the pt for the long haul. Once the admitting doctor and/or specialist is called and orders are given by that doctor, the rules change. If you have 3 doctors on the case, you'll have 3 different opinions many times. Much of the literature out there is for extended time on O2 rather than a 15 - 30 minute ambulance ride. As prehospital, you are concerned about meeting the pt's immediate needs for safe transport. That is your call to do what is best for your pt during the time he/she is in your care while staying within your guidelines given to you by your medical director and your license.

[emaxray]

My only question if a question at all. When something is being reviewed to be changed it's it pretty much up to those who want to change it to show reason for the change? Sounds like the ball is in his court. Perhaps it's he who needs to prove changing it will better the results.

[JPINFV]

I'll use the polite version:

Opinions are like noses. Everyone has one.

Sure about that one?

Besides, just because everyone has an opinion doesn't mean that all opinions are created equally. Saying, "Well, everyone has one" doesn't help anyone out.

[scratrat]

I've long felt that the difference in FiO2 between 10L/min and 15L/min is not clinically significant but does empty the tank one third faster.

Spock

As EMS providers, I think we're talking more about the difference between 4-6 lpm on a nasal and 10 to 15 on NRB, not the difference between 10 and 15 lpm. I never go above 10 unless they are draining the resevoir, but still, you can't treat everyone with a nasal @ 4-6 LPM.

[zippyRN]

'flow and concentration are mutually exclusive depending on delivery devices

ignore nasal cannulae for a moment as they are only really suitable for chronic disease management or patients who refuse a mask.

you can have high flow low concetration O2 - venturi masks - even if 'overdriven' w still deliver the advertised Fio2 withina few percent...

the volume of gas passing through a venturi mask often considerably exceeds 15 lpm

the partial or none rebreathing mask does deliver a high FiO2 and is often over used vs a .50 or .60 venturi if you have them

the prehospital management of COPD patients seems to be universally poor.

[tniuqs]

ZippyRN:

Are you sill using Venturi Masks in the UK?

Are there no RRTs in the UK?

Have you seen this new device?

I personally cannot endorse this product I have not seen enough research as of yet.

http://www.oxyarm.com/ourProducts_oxypubs.shtml

http://www.oxyarm.com/ourProducts_oxymask.shtml

I suspect if Ventmedic, basemedic or OZmedic see this post they may have some interesting input as well?

cheers

[VentMedic]

I haven't seen these items yet but I did come across some of the literature when I was researching alternatives to the Vapotherm which is still in FDA limbo. They look promising.

I hate venturi masks unless they're one unit and then I always find them on something different each time I do a pt check. With the "component piece together sets", I can never see the numbers and every manufacturer has their own set of colors.

[Ridryder 911]

We have a few services that utilize these devices. Since one can remove the mask and N/C and use the percentage desired, (similar to venturi) it makes it nice. The problems I have heard is the costs, as well the device has to be kept in its container as smashing or compressing it, will cause malfunction of the design of the mask.

R/r 911

[Richard B the EMT]

My comment on opinions was more geared to the doctors.

Until they finish their research, and convince the people who write the standards of care I must follow, I will continue to follow O2 therapy as per the protocols I currently operate under.

Sidenote: I honestly cannot remember the last time I even saw a venturi mask, let alone used one.

[zippyRN]

ZippyRN:

Are you sill using Venturi Masks in the UK?

yes - hence the comments about their use ...

Are there no RRTs in the UK?

no , we manage quite well without a further dilution of patient care to yet another 'single function professional' , also don't forget the UK is very much anti ringfencing roles at present , and most descriptions i have seen of the RT role are tasks undertaken by nursing staff and/or physios in the uk context

Have you seen this new device?

I personally cannot endorse this product I have not seen enough research as of yet.

http://www.oxyarm.com/ourProducts_oxypubs.shtml

http://www.oxyarm.com/ourProducts_oxymask.shtml

I suspect if Ventmedic, basemedic or OZmedic see this post they may have some interesting input as well?

cheers

i'm not even sure these products are on the UK market, i'm almost certain they are not in NHS supply chain and i haven't heard of anyone clamouring for them to be added.